ABSTRACT
This chapter describes patients undergoing therapeutic spinal cord stimulation (SCS) have a common problem in the loss of upper motor neuron functioning. It analyzes the amount and distribution of EMG activity thus elicited and the consistency of the responses to several repeated trials. SCS is an example of the use of sensory or afferent stimulation to modify abnormal motor control in patients with upper motor neuron disorders. The effects of SCS are presumably mediated by the dorsal columns, with secondary effects mediated by the autonomic nervous system, by additional ascending and descending tracts, by the propriospinal interneuron system, and by the gray matter of the spinal cord. The most commonly used method for achieving SCS is through a percutaneous approach using a spinal tap needle, such as a Tuohy or Hustead needle, modified by enlarging the distal opening. The usual precautions with regard to shock hazards from leakage currents must be observed when working with SCS equipment.
